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Introduction

Pandu(Anemia) as mixture of white and yellow colour which resembles with the pollen grains of Ketaki Flower.[1] Acharya Charaka who has mentioned that in Pandu there is Kshaya or loss of Varna or general complexion. [2] Acharya Charaka has also mentioned the word "Vaivarnaya" in this disease. It indicates that in Pandu , colour of the body become changed i.e. discoloration. This means, while describing the signs and symptoms of different types of Pandu , several types of complexion like Harita (green) etc. are described. But all of these are dominated by Panduta (Pale-Yellow colour) because of which this disease is called Pandu Roga. Sushruta says there is dominancy of Pandu Varna, so this disease is known as Pandu Roga. Acharya Charaka has described following etiological factors regarding Ahara. [3]

• Excessive intake of Kshara, Amla, Lavana, Ati ushna anna.
•  Virrudha Bhojana.
• Asatmya Bhojana.
• Excessive intake of Nispava, Masha, Pinyaka, Tilatail
• Excessive intake of Madhya
• Mridbhakshana
• Excessive intake of Kashya Rasa, Katu

Acharya Charaka has described the outcome of excessive use of Amala and Lavana Rasa. Also Sleeping, Exercise and Sexual Intercourse even before the food is not properly digested (Vidagdhe Anne Diwaswapna, Vyayama, Vyavaya). Suppression of natural urges (Vega Vidharana). Affliction of mind with Kama, Chinta, Bhaya, Krodha, Shoka. Improper administration of Pancha Karma Therapies (Pratikarma). Transgression of prescribed seasonal regimen (Ritu – Vaishmaya). [4]

Classification Of Pandu Roga: Classification according to Acharya Charaka

Acharya Charaka has classified the Pandu Roga of 5 types. [5]

(1) Vataja Pandu Roga

(2) Pittaja Pandu Roga

(3) Kaphaja Pandu Roga

(4) Tridoshaja Pandu Roga

(5) Mridbhakshanaja Pandu Roga

Classification according to Acharya Sushruta

Acharya Sushruta has not included Mridbhakshanja Pandu . Because according to him the variety of Pandu caused by Mrid-bhakshana is included in the Sannipatika variety of Pandu .So, according to him Pandu Roga is of four types. [6]

Classification according to Acharya Harita [7]

Acharya Harita has described 8 types of Pandu Roga.

(1) Vataja

(2) Pittaja

(3) Kaphaja

(4) Sannipataja

(5) Mridbhakshanaja

(6) Halimaka

(7)(8) Kamala

Acharya Harita has included Halimaka and two types of Kamala in the types of Pandu  Roga.

Samprapti: When the Doshas with Pitta as the most predominant one are aggravated in the Dhatus, then the Dhatus get afflicted with the result they become Shithila and Guru. Thereafter, the Varna (Complexion), Bala (Strength), Sneha (unctousness) and properties of Ojas get exceedingly reduced on account of the vitiation of Doshas and Dushyas. So, the patient becomes poor in Rakta (Alpa Rakta) and poor in Meda (Alpa Meda) and Nihsara and Shithilendriya and he suffers from Vaivarnya (Discolouration). [8]

 

Treatment of Pandu according to dosha Dominance

Vatika pandu [9]

Indulging in vata increasing diet and regimens aggravates vata leading to vatika pandu roga. The skin of the patient becomes blackish dawn colored and ununctuous. Its other symptoms are malaise, ache, pricking pain, tremor, pain in both the sides of the chest, headache; dried feces, distaste in the mouth; swelling, gaseous distention of the abdomen and weakness.

Paittika pandu [10]

Pitta gets aggravated by indulging in pitta vitiating nidanas (diet and regimens) which by involving the blood etc. causes pittaja pandu. Its symptoms are, change in complexion to yellowish/greenish, fever, burning sensation; morbid thirst and fainting; excessive perspiration and longing for cold things and environment. The person does not relish food, develops pungent taste, disfavors hot and sour things; gets sour eructations associated with burning sensation due to impaired digestion of food; emits foul smell from mouth; the urine and stool become yellow in color, has loose motions and develops weakness and fainting

Kaphaja pandu [11]

Aggravated kapha by indulging in kapha increasing diet and regimen gives rise to kaphaja pandu roga through the pathogenesis described earlier. The sign and symptoms of kaphaja pandu are heaviness, drowsiness, vomiting, whitish complexion, salivation, horripilation, prostration, fainting, giddiness, mental fatigue, dyspnea, cough, laziness, anorexia, obstruction in speech and voice, whitish coloration of the eyes, urine and feces; longing for pungent, ununctuous and hot things; and develops edema and sweet taste in the mouth.

Sannipataja Pandu

If a person indulges in all types of unwholesome food causing Tridosha Prakopa. Signs and symptoms of vitiation of all the three Doshas. This type of Sannipatika Pandu is extremely incurable (difficult to cure). Achayra Madhava have described some special symptoms of Sanniptaika Pandu and mentioned this type of Pandu “Asadhya.”

Discussion

Virechana Yoga for specific types of Pandu: Virechan Yoga for Vataja Pandu: In case of Vataja Pandu Krishapandwatha is the Varna mentioned. The synonyms of pandu are Kamala, Panaki, Khumbhava, Lagharaka. Even if so, all are explained as separate diseases having different Nidanas, Lakshanas and treatment. The features of vatika pandu were found present predominantly in the patients of the Iron deficiency anaemia. in this pandu Tikta drava sidhha Snigdha virechana is indicated

 Virechana Yoga for Paitika type of Pandu[12] - In Pittaj pandu, The yellowish discoloration in the various body parts is due to the increased haemolysis of RBCs, thus the increased bilirubin turnover, which leads to the development of other features described in paittika pandu. Some author opinion vitamin B12 deficiency anaemia can be correlated with Pittaj Pandu. [13] The patient suffering from paittika type of Pandu Roga should take half pala of the powder of Trivrita mixed with one pala of sugar.

Virechana Yoga for Kaphaja type of Pandu[14] - Some scholers corelate kaphaj Pandu Hypothyroidism with Anaemia. Shwetavbhasata is one of the main symptoms of Kaphaj pandu and it is found in every patient. [15] The patient suffering from Kaphaja type of Pandu Roga should take Haritaki impregnated with cow’s urine. [16]  Haritaki acts as Hetu and Vyadhi Veeprita Chikitsa for Kapha and Pitta both in Kaphaja Pandu Gomutra  is used for Virechana also because of its Rechka Guna.

Most suitable Drugs for Virechana Karma in Pandu: [17]

•  Virechana Yoga in General (Triphala Trivrit Kutaki kwath)

• After the patient is properly snehana, he should be given purgation therapy frequently with the Milk added with cow?s urine, Milk alone.

• Luke-warm infusion of Danti, Sprinkled with the powder of one anjali of fruit

• of Gambhari or infusion of Danti with paste of one anjali of Draksha.

• According to Sushruta Gomutra Danti, Haritaki Guda and Aragavadh Gana aushadi indicated for Virechana[18]

Role of Virechana in Pandu

Virechana (therapeutic purgation) is a common procedure that is widely practiced among the panchakarma treatments (pentad treatments).Virechana drug due to its Ushna, Tikshna, Sukshma Guna reaches to heart by the virtue of their potency and thereby circulates all over the body. They liquefy the morbid Dosha and bring them up to the Amashaya from here the morbid factorsthrough anal canal route are expelled out leading to Virechana. It has direct affect on Agnisthana and thus also helpful in increasing Agni.[19] Virechana has Srotovishodhana property hence it clears Srotorodha present in the disease Pandu . Thus, Virechana help in breaking the Samprapti of disease Pandu by clearing the morbid Doshas, which creates Khavaigunya and thereby relieving sign and symptom of the disease. Virechana causes mild inflammation to the GIT mucosa, which leads to capiilary Permeability of GIT mucosa, that’s why across it movement of those Molecules is possible which was not possible in normal state. Hence toxic substance come in GIT & get excreted.

Conclusion

Shodhana Chikitsa is performed mainly by employing Panchakarma. Virechana is less stressful procedure than Vamana Karma. It has less possibility of complications and could be done easily. The Virechana is considered as the best treatment for morbid and increased Pitta Dosha. Virechana also acts on specific Doshik dominant Pandu as it has tridosha Shodaka Property.